Liver Transplants and Depression: What the Research Shows

Depression is fairly common in the world of liver transplantation. The blues often set in before surgery: An estimated 31 to 50 percent of patients awaiting transplant experience some degree of depression. Even after transplant surgery, with a healthy liver in place, some patients begin or continue to feel depressed. One year after transplant, Hep C-infected patients (like me) experience greater depression than non-Hep C patients (they also have a lower quality of life and less physical functioning than other transplant patients).

As I looked for information about liver transplants and depression, what surprised me most was the lack of information on this topic. Granted, I only can access the research, journals and reports available online to the average layman who doesn't subscribe to medical search engines. Nevertheless, given the prevalence of depression in patients, I expected to find info more readily accessible.

If you have information on this topic, please leave a comment. Information is power... and to people (like me!) who are feeling depressed and tired, it could be a wonderful antidote.

When It Comes to Divorce, Organs Are Assets

From the "Are you kidding me?!" file is the current news story about a divorcing couple in New York and their bizarre battle over marital assets. Apparently, the husband considers his kidney an asset - that is, the kidney that he donated to his wife in 2001 - and "wants his estranged wife to return the kidney" or pay him $1.5 million as compensation.

What kind of crazy litigious society are we living in? I was divorced and know first-hand how incredibly difficult and emotional the process can be. But to try to leverage your position by asking for your donated organ to be returned? Sick, sick, sick.

This couple has three children. For the childrens' sakes, they need to wrap up the divorce and move on with their lives. Settle, people, settle!

Post-Transplant Depression: My Friends Stage an Intervention

Continued from my last post...

Apparently, my closest friends had noticed my unending depression, so like all concerned girlfriends, they talked amongst themselves. A LOT of them were in on the discussion, it seems - at least six that I know of, so far - and they also conferred with my husband about how I always seemed tired, hardly left the house, didn't socialize much, looked like crap and so on. Essentially, they felt that I was "stuck" and needed help - professional help - to move forward.

And so, one girlfriend called to say that she'd be near my home Friday morning and wanted to stop by for a quick visit. "Sounds good," I said. "Looking forward to seeing you."

On her way to my place Cari called to tell me that she would arrive soon. "By the way, Carolyn is stopping by, too," she said. Wow, I thought, This is great. It's going to be fun to catch up. I'm so gullible sometimes. Duh. It's Friday morning and two of the busiest people I know are skipping work to "pop in and for a quick visit." Yeah, right.

The gals arrived and with coffee mugs in hand, we settled into the living room and chit-chat ensued. Within a couple of minutes, though, the conversation turned serious. They told me how they had observed my blues, the rut I was in, the considerable duration of my depression. Carolyn and Cari confessed that they had spoken to others, including my husband. They explained their wish for me to work through my depression, and their belief that I needed professional help to do so. They told me about a good counseling resource that accepted my medical insurance and offered a few names.

After a few silent moments of pondering, I had to agree with them. I needed professional counseling to help me through my depression. The cost was a concern (we are BROKE!), but I pledged to make the necessary phone calls and obtain the assistance I needed.

A brief aside about friends: I often think about my friends and how much I value them. As stated on a needlepoint piece that was a gift from a girlfriend, "Friends are the family you choose." My friends truly are my family, because outside of my husband and children, they are my primary sources of encouragement and emotional support. Regardless of the need, I can always find friends' helping hands reaching my way. And if the need is extreme, my friends band together and "circle the wagons," as they did during my transplant.

My closest friends also love me enough to intervene, sit me down and tell me the harsh truth, even though it might hurt me to hear it. Not just anyone can get away with that. And there aren't many people I love and trust enough to hear clearly, even when the news is bad. Each of these friends is worth her weight in gold.

So I did as promised. It took about three weeks altogether, but I received authorization from our health insurance company, made an appointment and finally met with a counselor just before Christmas. I'll tell you about the appointment and about a long, difficult conversation with my husband - which proved to be my "Eureka!" moment - in another post. My next post is going to address transplants and depression, and some of the things I've learned about this issue and how it is - or isn't - managed through the healthcare system.

My Transplant and Depression: Life on the Dark Side

There is a television commercial that starts something like this, "What does depression look like...?"; it continues with sad pictures and images of people lying around with dark circles under their eyes, all the while promoting the merits of a particular antidepressant.

For more than two years now, I would argue that depression looks like me... me living life on "the Dark Side." I'd taken antidepressants on and off for years prior to receiving the news that I needed a transplant; the on-and-off nature of my medicine consumption occurred because when the antidepressants worked, I'd decide that I no longer needed them until a few months (or sometimes years) would pass, I would become depressed again and resume taking them. The transplant diagnosis made me pretty upset (absolutely freaked out, to be honest) and as I became sicker and more worried about the surgery, I became more depressed. So my internist increased my antidepressant, telling me that many or most transplant patients take antidepressants because of the emotional impact of the surgery and recovery.

Six or seven months after my difficult and complicated transplant, I was again depressed, due to seemingly endless health issues, financial problems, inability to be Super Mom (or even Average Mom). The load was taking its toll and I couldn't seem to snap out of the blues. Both my local internist and my hepatologist at the transplant center urged action, so my antidepressant dosage was increased again.

And so for the next 15 to 18 months I dragged along. Whenever my energy level improved I'd feel better, more positive - but then one of the seemingly never-ending "hiccups" would occur, I wouldn't feel so well and then I would become frustrated and depressed once again. It sucked. I stayed home, rarely wore makeup, napped often, grumped "Why don't I feel better?" and fruitlessly tried to exert control over an uncontrollable situation. Yes, depression looked like me.

My internist was concerned. I was taking about as much of my antidepressant as was reasonable, so she recommended cutting back on it and adding a second one to balance out my moods and hopefully help boost my energy and sense of well-being. At that time, however, I was experiencing increases in some of my liver function lab tests - not a good sign. I thought it would be best to delay adjusting any meds until the labs/liver function matters were sorted out, so I bided time by wringing my hands and worrying about my new liver. Finally, after six weeks or so, the labs stabilized and I could consider starting the new antidepressant.

And then came the intervention.

I'll tell you about that on my next post.

New Year, New Attitude

It's January 1, 2009 and I know many people are elated to see 2008 end. It was a very tough year for me and my family, but there were plenty of bright spots, too. I would categorize last year as "transitional," with lots of changes, challenges and learned lessons.

One of the most significant lessons I learned was about my health and ongoing depression (since my transplant; it worsened over time). I'll be posting about that on this blog over the next few weeks - many, or most, transplant patients (and people with other chronic illnesses) struggle with the blues in some fashion and perhaps reading about my experiences will prove helpful, in a what-not-to-do way.

I look forward to 2009 with a new attitude, with optimism and hope, reflecting on the message I discovered in a fortune cookie:

"Your path may be difficult, but will be rewarding."

Photo credit: Radu Andrei Dan

Yet Another Post-transplant Email - I Finally Leave ICU after 18 Days!

Friday, December 22, 2006 11:26 a.m. (sent by Gene)

Dear friends,

News Flash: Jay is out of ICU!

I just wanted to send a quick note to share the good news... Jay just continues to surprise... on Tues. evening (12/19), she endured another round of complications that I was convinced would set her back. But Jay bounced back miraculously the next day, and then last night - after 18 days in ICU - the doctors pronounced her healthy enough to move to intermediate care!

Within the last 24 to 48 hours, Jay has:
* completely stopped using the ventilator; breathing all on her own. (She still has a trache tube as a precaution, but this likely will be removed within a few days. Should be able to talk soon.)
* started sipping drinks (water, Gatorade, apple juice).
* yanked out her feeding tube - for the third time! Nurses not happy about this development, but finally have caved in to Jay's persistence. They now say if she can eat enough food on her own and get sufficient nutrition, she can ditch the tube.
* ordered husband to fetch her a hamburger meal. He refused following doctor's orders; Jay not happy with husband.

That's all the good news I have for now, but it should be plently. Thanks for all of your prayers... they are definitely working.

I'm off to visit Jay in her new room...

Gene

Happy Birthday to My Liver

Today – December 3rd – is my other birthday.

Two years ago I had the liver transplant that saved my life. Last night, my husband and I reminisced about how the experience unfolded: THE telephone call that came midday on Dec. 2nd; a flurry of phone calls, arrangements, packing; the two-hour ambulance ride through a drenching thunderstorm; all the rushing, just to get to the hospital and then having to wait six hours for surgery to begin (the operation started around 1:00 am, which is why Dec. 3 – not 2nd – is my other birthday). And ultimately, good news that the transplant was successful.

I am grateful and humble when I remember this day and all that went before and after. There are many, many people to thank; please indulge me while I recognize just a few of them:

* First and foremost, my husband, Gene, who walked every step with me. I had it tough, but at least I was on drugs. He persevered through it all, God bless him.
* Carolyn, Chris, Happy and Dene, who traveled to the transplant center with us and helped Gene survive the hours of waiting both before and during my surgery
* Carolyn also visited often and was the positive force that kept Gene’s spirits up, spoiled the kids with Christmas gifts (Wii? Tiffany’s bracelet? I was NOT consulted about these gifts!) and was the glue that kept our world together
* Regina, who dropped everything and put her life on hold to stay with our kids for two weeks AND had our carpet cleaned while she was here
* Larry, who with Chris, helped our son transition into crew and made sure he always had transportation to and from practice
* Karen, who visited frequently, drove kids to and fro, and made sure the whole family received new pajamas on Christmas Eve
* Cari, who along with Carolyn and Karen, made sure the kids had a fabulous Christmas and plenty of gifts, including the leopard print desk chair
* Peggy and Dave, and Pam and Steve, who hosted our children several times and always at the spur of the moment
* Debbie, who was master of the “feed Jay’s family” schedule – no small feat – and kept it organized for many months while I recuperated
* Gary, with Dene, who took the kids on an eight-hour (one way) road trip to attend a family gathering, and who endured Dene’s absences while she babysat me once I finally returned home from the hospital
* Helen, the fabulous type-A powerhouse who drove two hours to visit me in the hospital and rub lotion on my feet (is there anything better?!), and together with her husband, Rick, secretly continue to do many good deeds that make the world wonderful
* Sally and Angie, who made sure our power bill got paid * Allen, who with Happy, brought me communion every week for months and prayed for me and my family
* Rosemary and Dick, who sent me a prayer shawl from their church in Huntsville

These are just some of the countless people who helped us time and time again, each and every one of whom I cherish. Thank you to these friends and family who were the key support system that sustained us. My sincere gratitude, too, to Dr. B, Laura, Theresa, Dr. S, Dr. K, Dr. Z, Dr. R and so many other medical professionals who kept me alive.

Dec. 3rd will always be an extraordinary day in my world. My family will celebrate tonight with a special dessert – chocolate chip cookies made by my daughter. Yeah!

For everyone waiting for or recovering from transplant surgery, I send you my best wishes. It can be a long, tough road but in the end, it’s well worth the struggle and sacrifice.

God bless.